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City of Northampton Mail-RE: control;construction waiver https://mail.google.com/mail/?ui=2&ik=3921Iafc3d&view=pt&search...
Charles Miller<cmiller @northamptonma.gov>
RE: control; construction waiver
1 message
Jiml-awrence<jcl @crocker.com> Mon, Sep 30, 2013 at 9:17 PM
To: Charles Miller<cmiller @northamptonma.gov>
Chuck, Thanks for sending the form.We removed the suspended ceiling panels and found a probable bearing wall had been
removed and now the job has shifted and the waiver may not be needed. The application can go to the wait and see file. Jim
Lawrence
From:Charles Miller[mailto:cmiller @northamptonma.gov]
Sent: Friday,September 27, 2013 3:23 PM
To:jcl @crocker.com
Subject:control;construction waiver
See Attached
Chuck Miller
Assistant Building Commissioner
City of Northampton
Town of Williamsburg
(City of Northampton E-mail is a public record except when it falls under one of the specific statutory
exemptions.)
I of 1 10/2/2013 11:21 AM
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual): James Lawrence
Address:85 Mountain St.
City/State/Zip: Haydenville, MA 01039 Phone #:413-268-7099
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.9 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8, ❑ Demolition
working or mein an capacity. employees and have workers'
g Y 9. E] Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' l3.❑ Other
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
9/26/13
Signature: Dat e:
Phone#: 413-2687099
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Version i.7 Commercial Buildine Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering StfUCtUrat Peer Review Required Yes 0 No 0
SECTION 1't -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Cie ald Cohen ,. 1� t
�1_ _ as Owner of the sublect oroperty
i
I�11i1c S l...mvrence
"ereby'a>ho ize to
i F-r op ehalI." ri ' It er rei etc yvork a :boil ed by ihss building permit application.
S!-n ,ur2 Of Owner
ate
9 j
i _lames Lawrence
as Owner;Authonzed
Agent hereby declare that the statements and !nforrrtaticn on the foregoing apps=.cation are true and accurate,to the best of my knowledge
I and belief_
Signed under the pains and penalties of perjury.
E
j Print Name
II
Sigr�aiure of ilwnert;'�gent Lake
SECTION 12-CONSTRUCTION SERVICES
_ ........
10.1 Licensed Construction Supervisor: Not Applicable LJ 1
James l.a�arenee
License 10092
Name of License Holder I
—_ __._. _......_ .---.__ _
e Number
8? Morn Lain St. I lavdenuille, MA (1)0339 � i ?,? .2O!
Expiration Date
(41 3) 208-7099
4icnattrce Teieph,,e
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application Failure to provide this affidavit wai result
in the denial of the issuance of the building permit
LSigned Affidavit Attached Yes No 10
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Gerald Cohen as Owner of the subject property
hereby authorize James Lawrence to
act on my behalf, in all matters relative to work authorized by this building permit application.
X
Signature of Owner Date
James Lawrence as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
E $ [.J ruw '9z
Print Name
Signature of 04er/Ag6nt ! Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
James Lawrence CS-010092
Name of License Holder. .
License Number
85 Mountain St. Haydenville,MA 01039 12/23/2013
Address Expiration Date
(413) 268-7099
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes G) No 0
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
James Lawrence Not Applicable ❑
Company Name:
James Lawrence
Responsible In Charge of Construction
85 Mountain St. Haydenville, MA
Address
(413) 268-7099
Signatur Telephone
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be tilled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:,,.
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations E) Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New igns❑ Roofing❑ Change of Use❑ er❑
Brief Description I Enter a brief description he : add two new partitions, replace ceiling
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly El A-1 ❑ A-2 El A-3 1:1 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34):' Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1st 1sr
2nd 2nd
3rd 3rd
4 t
4h
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone[-] Municipal ❑ On site disposal system❑
\`ers ion I.;Con niercial Building;N:rmit 1lati 15,2000
Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
212 Main Street iSewer/SepticAvailability
Room 100 Mater=eit Availability
{
(Northampton, MA 01060 Two Sets of Structural Plans I
9 phone 413-587-1240 Fax 413-587-1272 3l Plot/Site Plans
;Other Specify
t
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING j
OTHER THAN A ONE OR TWO FAMILY DWELLING
f SECTION 1 -SITE INFORMATION
1.1 Property Address
This section to be completed by office
182 Main St. Second floor Map tot unit l
Zone Overlay District
– —_ Elm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT—� —
2.1 Owner of Record:
Gerald Limited Part. 63? Washinizton St. Brookline, MA 02446
Name(Print) �' Curreni Mailing Address:
(1z 9
¢` (f�l i' 1_�� 64'
S,g natur'° — Tdeph-one
f 2.2 Authorized Aoent:��—
.lames Lawence 85 Mountain St. flaydenville, 1ILA 01034
dame(Pant; „uirent Mailing address:
(41!) .'.68-7()1M
S'anaiure Telephone
SECTIO TIMATED CONSTRUCTION COSTS
Item Estimated Cost Dollars)to be Official Use Only
Completed by permit applicant
1 Building ;a)Building Permit Fee
s I',01)0.(30
E:ec`rical S4,800,00 (t)Estimated Total Cost of
_Construction from(6)
( 3 Plumbing -- Building Permit Fee �— —
I
4 Mechanical iHVAC)
Fire Protection
1.000.00
6- I'tai=(1 + 2+3+4 + 5) — heck Number � —
�� This Section For Official Use Only
Buildino Permit Number Date
issued
5!QnatUfe; —�
Building Commissionerllnspector of Bu,ldings Date
- Version 1.7 Commercial Building Permit May 15,2000
f Department use only
f=---- City of Northampton Status of Permit:
f Building Department Curb Cut/Driveway Permit -
SEP 2 7 2013 ` 212 Main Street SeweriSepticAvailability
Room 100 WaterWell Availability
E4 ctric,Plumbing&Gas inspections Northampton, MA 01060 Two Sets of Structural Plans, !
Northam ton,MA D1060 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other'Speclfy
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office'
182 Main St. Second floor Map 311 Lot )kp) Unit
Zone Overlay District
Elm St;District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Gerald Cohen/Bermor Tauton Limited Part. :637 Washington St. Brookline,MA 02446
Name(Print) Current Mailing Address:
/��/) (617) 938-6485
Si
gnatur �I► � /� Telephone
2.2 Authorized Agent:
James Lawence 85 Mountain St.Haydenville, MA 01039
Name(Print) Current Mailing Address:
(413) 268-7099
Signature Telephone C L 6&
C.N`
SECTIO STIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building $18,000.00 (a)Building Permit Fee
2. Electrical ' (b)Estimated Total Cost of
$4,800.00 Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) • ego
5. Fire Protection $1,000.00
6. Total=(1 +2+3+4+5) C>C1 Check Number
This SCection For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0380
APPLICANT/CONTACT PERSON JAMES LAWRENCE
ADDRESS/PHONE 85 MOUNTAIN ST HAYDENVILLE (413)268-7099
PROPERTY LOCATION 182 MAIN ST
MAP 3 1 D PARCEL 162 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ADD 2 PARTITIONS &NEW CEILING
New Construction
Non Structural interior renovations
Addition to Existing
Accessoly Structure
Building Plans Included:
Owner/Statement or License 010092
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.